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A 7 9-year-old man with advanced gallbladder cancer (stage IVa) underwent chemotherapy with single-agent gemcitabine (1,400mg/body: day 1, 8, 15, every 4 weeks) as first-line chemotherapy. As soon as the chemotherapy started, the carbohydrate antigen 19-9 (CA19-9) level was notably reduced, and after 4 courses, CT scan revealed that the tumor was markedly reduced in size. We thought he could undergo curative operation, and performed and extended cholecystectomy and lymph node dissection. Intraoperative findings revealed that the gallbladder atrophied and, with no obvious invasion to adjacent organs, a small hard mass like only fibrosis was confirmed. Then, 18 days after the operation, he was discharged without any complication. In the histological findings, cancer tissue was replaced by fibrosis, and malignant cells could not be detected. Now the patient has remained well without recurrence after 6-month follow-up. Many clinical trials show that gemcitabine, which is used as a single agent or combined with other agents (for example, cisplatin), demonstrated high efficacy with manageable toxicity in patients with advanced or metastatic biliary tract cancer. For this disease, including gallbladder cancer, gemcitabine is the mainstay of chemotherapy, and it is thought that this agent could have high efficacy in many cases.

In this study, we investigated serum-soluble interleukin-2 receptor (sIL-2r) and neopterin (NPT) levels in five patients with severe postoperative infections. A total of 25 synchronous determinations of sIL-2r and NPT were performed. A marked increase in sIL-2r and NPT levels was observed, and the increase in sIL-2r was significantly correlated to that of NPT which is a marker of macrophage activity. These results suggest that macrophages are involved in the stimulation of sIL-2r release, representing a potentially negative biological effect. The results indicate that sIL-2r may be a useful indicator of the efficacy of antibiotics and of prognosis.